Indian Journal of Anesthesia and Analgesia

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This short communication was aimed to address the role of physical activity by updating the existing evidence from a literature overview of studies on prevention and treatment of chronic pain. Experimental evidence suggested that physical activity might prevent development of chronic pain. Treatment of chronic pain using quota-based exercise/physical activity programs not only produced increases in activity but also subjective expectancies of capability. Cognitive behavioural strategies incorporating exercise/physical activity aims in improving fitness, counteracting unhelpful beliefs and improving stress levels in people with chronic pain. Exercise positively influenced pain behaviours and pain perceptions, activated endogenous analgesic mechanisms and has immediate anti-depressive and anxiolytic effects. A comprehensive supervised exercise program (stretching, strengthening, balance training, aerobic training) with or without motivational interviewing demonstrated beneficial effects on people with chronic pain. Evidence-informed recommendation for physical activity existed for chronic low back pain and fibromyalgia.

Neurocysticercosis is a parasitic neurological infection caused by the ingestion of larvae from the adult tapeworm Taenia solium. We describe a man who presented with severe headache post herniorrhaphy under spinal anaesthesia. A diagnosis of PDPH with meningismus was made by neurologist and a MRI was performed to further investigate the cause. His initial MRI showed multiple characteristic cystic lesions in observance with Neurocysticercosis.

Background: Efforts to find a better adjuvant in regional anaesthesia are underway since long.Aims and objectives are to compare the efficacy of epidural block with ropivacaine or ropivacaine plus dexmedetomidine for relief of post operative pain in patients undergoing abdominal hysterectomy surgery. Methodology: Sixty adult patients of ASA grade I & II, undergoing abdominal hysterectomy surgery were included in this prospective, randomized study. After placing the catheter in L1-L2 epidural space, block was randomly activated either by 18 ml of ropivacaine 0.25% (Group I) or by 18 ml of ropivacaine 0.25% plus 1µg/kg dexmedetomedine (Group II). General anaesthesia was instituted in all patients using a standardised technique. After recovery from GA, pain was assessed by VAS. The patients were administered first top up dose through epidural route as soon as VAS score exceeded 3 and time was noted for duration of analgesia. Total requirement of ropivacaine in 24 hours was also noted. Result: Mean duration of analgesia was longer in Group II (318.14±54.35 min) as compared to Group I (146.21 ±30.64 min) (p<0.05). Mean total consumption of ropivacaine was 89.42±12.32 mg in Group II and 122.36(14.26) mg in Group I (p< 0.05). Conclusion: Addition of dexmedetomidine to local anaesthetic agent ropivacaine significantly prolongs the duration of analgesia in epidural blocks.

 Background: Central vein cannulation (CVC) in pediatric patients with congenital heart disease is a challenging task due to unpredictable altered anatomy. So the means to improve the success rate and minimize the complications of CVC must be sought after. Material and Methods: This prospective, randomized study involved 60 children divided into two groups (n=30 each). Children less than 12 years were included and those with any neck swelling and/or undergoing univentricular repair surgery were excluded. Patients were induced with oxygen:sevoflurane, midazolam (0.1mg/kg IV), fentanyl (5-10 mcg/kg IV) and Inj. pancuronium (0.1 mg/kg IV). Internal jugular vein was cannulated using conventional anatomical landmark technique in group I and using USG in the group II. Time of the procedure was calculated once painting and draping was done until cannulation of an IJV. Left IJV and femoral vein cannulation was performed in case of inability to cannulate right IJV. Results: The percentage of successful first attempt cannulation was 36.66% in landmark group whereas in USG group it was 73.33%. Mean number of attempts in both the groups were 2.03 ± 1.13 vs 1.37 ± 0.72 in the landmark and USG group respectively.(P=0.008) Time required for procedure was more in the USG group (45.17± 25.61 vs 68.7± 48.98 seconds).[P=0.023] Carotid artery puncture occurred in 43.3% cases in landmark group as compared to 10% in the USG group.[P=0.004]. Conclusion: Ultrasound guidance reduces the number of needle passes needed to puncture the vein, increase the overall success rate of venous puncture and minimizes complications such as arterial puncture or pneumothorax.

 Context: spinal anaesthesia is advantageous in that it uses small dose, simple to perform and offers a rapid onset of action, reliable surgical analgesia and good muscle relaxation. First report of paediatric spinal anaesthesia was published by August Bier in 1899 with Cocaine in 11 year old child for ischium abscess drainage. Aims: To compare the efficacy, duration, quality and side effects of intrathecal Bupivacaine alone and Bupivacaine plus clonidine in paediatric patients. Settings and Design: Patients were randomly allocated in two groups. Group-A received Bupivacaine 0.5% heavy (0.4mg/kg for 5-15kg or 0.3mg/kg for >15 kg) and Group-B received Bupivacaine 0.5% heavy (0.4mg/kg for 5-15kg or 0.3mg/kg for >15kg) and preservative free Clonidine (1 mcg/kg). Methods and Material: A prospective randomised double blind study was carried out in 60 ASA-1 paediatric patients undergoing surgeries below T8 dermatome up to 2 hrs duration. Patients were randomly allocated in two groups. Group- A and Group- B comprising 30 patients each. Time of onset of sensory block, maximum level of sensory block, duration of sensory block, duration of post-op analgesia and side effects were observed. Statistical analysis used: Data obtained was subjected to statistical computation and analysed using computer programme statistical package for social science (SPSS) ver-16.0 and test performed were unpaired student-t test, nonparametric mann-whitney two samples test and Chi square test. Value of p <0.05 was considered significant and p<0.0000001 highly significant. Results: addition of preservative free clonidine (1mcg/kg) to 0.5% hyperbaric Bupivacaine provides prolonged spinal anaesthesia, superior pain relief and better sedation without causing severe adverse effects compare to Bupivacaine alone. Conclusions: Clonidine is better adjuvant to Bupivacaine in spinal anaesthesia as far as patients comfort is concerned. It decreases the time taken for onset, produces longer duration of both surgical anaesthesia and postoperative analgesia and better quality of sedation with no added side effects as compare to Bupivacaine alone, in paediatric patients undergoing surgeries below T8 dermatome.

 Handheld devices like smart phones, once viewed as a diversion and interference have become an integral part of healthcare. Medical informatics helps us by analysing complex data in making clinical decisions and knowing recent advances at the point of patient care. Together handheld devices and Informatics is changing the way medicine is being practised. The anaesthesia and critical care related applications are discussed and possible drawbacks are also discussed.

Keywords: Informatics; Anesthesia informatics; Anaesthesia; Critical care; Devices; Smart phones.

The aim of the study was to compare the relative potencies and clinical characteristics of epidural Clonidine and Fentanyl with Bupivacaine in lower limb and lower abdominal surgeries using patient-controlled analgesia. In a randomised double-blinded study, 60 ASA I or II patients requiring epidural analgesia for post operative pain relief were allocated to receive either 0.125% Bupivacaine with Clonidine 1µg/kg or 0.125% Bupivacaine with Fentanyl 1µg/kg via a sterile syringe by trained anaesthesiologists. Analgesia was established with 10-15 ml bolus of study solution. There were significant differences in onset time, duration and quality of analgesia, local anaesthetic consumption, between the two groups. We conclude that 0.125% Bupivacaine with Clonidine 1µg/kg group of patients clinically had better quality of analgesia and for a longer duration in comparison with patients receiving 0.125% Bupivacaine with Fentanyl 1µg/kg.